Differentiated cost shares for medicines

The cost share (copayment) for medicines is generally 10 per cent of the costs in excess of the annual deductible. If the specialities list (SL) contains more than one medicine with the same active substance(s), the cost share can be 40 per cent instead.

A higher cost share can apply if the patent of a substance has expired and generics or – in the case biologics – biosimilars are available and contained in the specialities list. A higher cost share can thus apply to original preparations, co-marketing medicines, generics, reference products and biosimilars.

The cost share for medicines whose ex-factory price exceeds a specific limit is increased to 40 per cent of the costs in excess of the annual deductible.

Drugs subject to a higher cost share are marked with an X on a red background in the “SB” column of the electronic specialities list (available at www.spezialitaetenliste.ch).

The doctor, chiropractor or pharmacist must inform the insured person if at least one generic medicine that can be substituted for an original preparation is listed in the SL, or if at least one biosimilar medicine that can be substituted for a reference preparation is listed. The insured person must also be informed if a medicine is subject to an increased cost share of 40 per cent.

The limit described above is calculated by adding 10 per cent to the average ex-factory price of the cheapest one third of all drugs on the specialities list with the same active substances. These limits are set by the FOPH on 1st December of every year, or when the first generic or the first biosimilar is added to the specialities list.

Predicted cost share

The limits listed below apply from 1st December 2023 to original preparations and generics and from 1st January 2024 to reference products and biosimilars. For the currently valid cost share the information contained in the SL is always applicable (available at www.spezialitaetenliste.ch).

Last modification 14.03.2024

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Federal Office of Public Health FOPH
Health and Accident Insurance Directorate
Review of pharmaceuticals Section
Schwarzenburgstrasse 157
3003 Bern
Tel. +41 58 483 96 48

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